Sleep. Medicine. Music. Life.

Category Archives: Parasomnias

Stories like this one from yesterday seem far too common these days. Here is some remarkable surveillance camera video recently released, demonstrating a Boston-area woman ambling slowly forward and right into a subway station pit and onto the subway tracks.

Amazingly, this woman wasn’t seriously injured in the incident, and by report she later told authorities that she had fallen asleep on a nearby bench and that she probably sleepwalked onto the tracks. According to the clock on the video, this incident took place at 8:41 in the morning.

Here’s just a brief word on sleepwalking, a fairly common phenomenon particularly in children, teenagers, and young adults. Sleepwalking is a form of non-REM parasomnia–in other words, an unusual movement or behavior occurring during or immediately out of non-REM sleep (i.e., non-dream sleep). Such events tend to occur more frequently if you are in a position in which you tend to have a lot of deep non-REM sleep (such as if you are sleep-deprived) or if there is something in or around you that causes abrupt arousals from sleep. In the case of this particular woman, I have not been able to find a lot of specific information in the media pertaining to why this incident occurred, but if she had fallen asleep waiting for her train around 8 or 9 in the morning, chances are probably good that she had been sleep-deprived (otherwise she probably wouldn’t have fallen asleep there in the first place), and being in an environment with lots of loud noises (have you ever been in a T-station in or around Boston?), well, this seems like a set-up for a possible sleepwalking event.

Our modern world is crazy. Our lives are fast and furious; we work hard, we study hard, we play hard. But our busy lifestyles don’t make the need for sleep any less important. Most adults need around 7.5 to 8 hours of sleep per night to feel fully rested. Ask yourself how often you are making time for that much sleep at night. My main take-home point for you this afternoon: getting proper amounts of sleep, and regularly, may prevent a whole host of potential problems during the day, ranging from reduced work productivity to fall-asleep car crashes to unusual behaviors such as sleepwalking. And perhaps getting proper amounts of sleep each night may even save your life.

Hello everybody! I’m writing this brief entry tonight to address something a lot of people, particularly parents of young children, can be confused about: the difference between nightmares and night terrors. I’ve heard people use these terms interchangeably, but they represent entirely different clinical entities. Herein I provide a simple distinction between the two.

Night terrors–also known as “sleep terrors” or “pavor nocturnus“–are very memorable for parents. Here’s a typical scenario. Your child goes to bed the way she usually does at night. Later that night, suddenly, from her bedroom comes a loud, blood-curdling scream that scares the hell out of you. You jump out of bed and run to your daughter’s bedroom. You find her sitting up in bed, appearing awake and dazed, eyes wide open in fear. She may or may not respond to you. She appears distressed and freaked out, sweating and breathing hard; she may move her arms and legs nonspecifically but frenetically as well, compounding your concern as you observe her. She seems panicked and inconsolable, almost possessed. After several minutes, though, she calms down, lies down again, and returns to sleep. The next morning, when you ask her about the event, she tells you she has no idea what you’re talking about: she recalls nothing of what happened.

Here’s a nightmare. You hear your child crying or crying out for you in the middle of the night. You enter his room. He’s clearly awake and clear-headed, and answers your questions appropriately and quickly. He may hug you for comfort. You ask him what happened. He tells you he had a terrible dream; a monster was out to get him, for example, or he was about to be pushed off a cliff by someone mean. He has good recollection of what he was dreaming about. After some reassurance, he eventually feels comfortable enough to return to bed, and the following morning he may or may not recall the full details of the disturbing dream, but he does remember that he had a terrible dream that caused him substantial distress.

The reason why it’s important to recognize the difference between these two clinical entities is because both can concern and frighten parents, particularly night terrors. As frightening as they may be to watch, however, they are in and of themselves generally benign in nature and prognosis.

Night terrors represent a type of parasomnia (sleep-related unusual movements or behaviors) typically occurring out of deep non-REM sleep. As such, dreams are not recalled, and the child is usually completely amnestic of the event. Though some adults may experience night terrors, they are by far most common in children 3-12 years of age. As scary as these events are for parents, they are usually not indicative of an underlying abnormality or medical problem, and children with night terrors usually outgrow them over time. In some children, sleep deprivation or other reasons for going to bed particularly fatigued or sleepy may play a role in the likelihood of night terrors occurring, so make sure that your child gets proper amounts of sleep and sleeps in reasonably predictable, regular schedules night after night.

Nightmares are simply particularly unpleasant and/or frightening dreams. They occur out of rapid eye movement (REM) sleep, and are usually recalled–and often recalled well–upon abrupt awakening from dream sleep. For whatever reason, 2/3 – 3/4 of human dreaming is emotionally negative in nature (I had a distinctly negative dream early this morning, for example, though I wouldn’t classify it as a nightmare; hence I’m writing this entry today!). Most people don’t need specific treatments for nightmares, and how to treat recurring nightmares is controversial.

I think I’ll write a little about recurring nightmares some time soon. It might be cathartic for me.

Have a good evening, everybody. I hope your dreams tonight are positive and pleasant.

I’ve loved Lyle Lovett‘s music for decades. I met Lyle, quite by chance, in 2006 at the Dallas / Ft. Worth Airport International Airport, my layover between the Bonnaroo and the national sleep medicine meetings. He is the consummate Texas gentleman, pure class both onstage and off. It was an absolute pleasure to get to know him.

Among Lyle Lovett’s many great songs is “Sleepwalking,” from his 1998 album, Step Inside This House. As humorous as this song is (see the lyrics below), Lyle sings with substantial clinical accuracy regarding the mysterious phenomenon of sleepwalking, also known as somnambulism.

Sleepwalking represents a series of complex behaviors that tend to arise from arousals from non-REM sleep. Sleepwalkers walk about in an altered state of consciousness, often appearing confused or “glassy-eyed.” Judgment appears impaired. There can be variable degrees of interaction with their surroundings and with other people. Sometimes interactions with others can be inappropriate above and beyond the apparent confusion; agitation or even violence may occur in this setting. In the morning, upon awakening, they are usually partially or completely amnestic of the previous night’s sleepwalking event.

Because sleepwalking and other related parasomnias (the clinical spectrum of unusual movements or behaviors that occur during or out of sleep) tend to occur following abrupt arousals from deep forms of non-REM sleep (called “slow wave sleep“), it stands to reason that people who have lots of deep sleep at night may be particularly prone to sleepwalking. As such, those who are sleep-deprived or who have preceding insomnia (such as the protagonist in Lyle’s song) can be predisoposed to sleepwalking. Other factors that may increase a person’s risk for sleepwalking would include alcohol use; certain medications; previous head injury and other neurologic disorders; travel or sleeping in unfamiliar environments; and stress. In addition to avoiding these predisposing factors, it’s important for sleepwalkers to do what they can to get proper amounts of sleep each night–thus preventing or minimizing sleep deprivation, which leads to increased slow wave sleep–and keep their sleep schedules regular.

Here, now, are the lyrics to this great song. Enjoy!

Sleepwalking
(Willis Alan Ramsey)

Last night you know I couldn’t sleep
I was tossing, turning, and counting sheep
To tell the truth
The next thing I knew
I woke up on the outside
In the middle of the avenue

A policeman spied me in traffic there
In my t-shirt and my underwear
He said, “Son, Son
It sure don’t look good
The way you’ve been calling for your baby
All over the neighborhood”

It seems I was sleepwalking
Again last night
The way I was sweet-talking
It must have caused a terrible fright
Last night, you know when I was sleepwalking

Someone saw me at a doughnut shop
I was sitting and crying on a tabletop
It was not a pretty sight
I was out of control
The way that I was carrying on
About my sweet jelly roll

I said, “Officer please
My baby’s got me down on my knees
Lying in bed
Late at night
Sometimes I just go out of my head
At night
And I go out sleepwalking”

Later on, down at the jail cell
I was hoping things would turn out well
Because I don’t recall
That masquerade ball
And I sure don’t remember nothing y’all
About that blown up rubber doll

It seems I was sleepwalking
Again last night
The way I was sweet talking
It must have caused a terrible fright
Last night, you know when I was sleepwalking

So lately I’ve stopped going anywhere
And I’ve taken to sleeping with a teddy bear
It’s a very full and rich
Imaginary life
And it’s sure enough better than dreaming y’all
About any imaginary wife

No more sleepwalking
No more dreamtalking
No more sleepwalking
No more sleeptalking